Provider Demographics
NPI:1962652826
Name:BRENNAN, MYRA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51489
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02205-1489
Mailing Address - Country:US
Mailing Address - Phone:781-361-3000
Mailing Address - Fax:
Practice Address - Street 1:24 SHIPYARD DR STE 203
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1673
Practice Address - Country:US
Practice Address - Phone:781-361-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics